Healthcare Provider Details

I. General information

NPI: 1841797420
Provider Name (Legal Business Name): SUSAN F EPSTEIN PHD, LICENSED PSYCHOLOGIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W 86TH ST APT 1C
NEW YORK NY
10024-3663
US

IV. Provider business mailing address

3524 78TH ST APT B11
JACKSON HEIGHTS NY
11372-4705
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-3633
  • Fax:
Mailing address:
  • Phone: 646-250-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number016655
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number016655
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number016655
License Number StateNY

VIII. Authorized Official

Name: DR. SUSAN F EPSTEIN
Title or Position: OWNER
Credential: PHD
Phone: 646-450-3633